Dr. Keith Roach: Reactive blood pressure causes treatment confusion
Dear Dr. Roach: I am sensitive to blood pressure machines. Whether on my wrist, arm or leg, they hurt, and my blood pressure goes up. This has resulted recently in a dentist not wishing to extract a tooth because her machine measured my pressure at 190/98. A few years ago, prior to minor surgery, the machine got a similar result. They tried to inject me with something to bring it down, and it went down alarmingly low. During visits to my primary-care physician, my pressure is consistently around 138/82. An old-fashioned cuff is used, and is gently and slowly pumped up. I feel I am at risk of medics misunderstanding this and refusing treatment or overreacting. Is my case unique or do others have the same problem?
Dear R.W.G.: Many people react when their blood pressure is being checked, and it almost always makes the blood pressure higher. It sometimes can be very difficult to know if the blood pressure is really elevated or if it is reactive hypertension (“white-coat hypertension”).
In your case, the easiest solution seems like asking to have an old-fashioned manual blood pressure draw by a trained clinician who can gently and accurately take your pressure. You also need to warn the other clinicians besides your PCP that automated blood pressure cuffs have this effect.
As a primary-care doctor, I often have to decide if the blood pressure elevations are reactive to the situation, so I routinely recommend checking the blood pressure at home several times weekly between visits. There are automated blood pressure devices you wear for 24 hours, which take blood pressure every 15 minutes or so. Many people react poorly initially, but, after a few hours, don’t even notice when the device inflates. Occasionally I have to resort to looking for signs of damage to the heart or blood vessels of the eye to decide if the reactive blood pressure needs to be treated.
Email questions to ToYourGoodHealth@med.cornell.edu.